[Click here for Part 1]

PART 2

MEETING THE CHALLENGE

Virtua Health's successful "get human fast" online engagement platform propelled patients to interact with staff and clinicians expanded to virtual consultations, chatbots and RPM. The enterprise health system created six distinct service lines supported by the Centers for Disease Control and Prevention.

The six virtual care programs are as follows.

First, Urgent Care Telehealth.

"UCTH treats a range of conditions with extended hours 365 days a year via browser-based video visits," said Dr. Angela Skrzynski, clinical lead for urgent care telehealth for COVID-19 remote patient monitoring and care after COVID-19 programs at Virtua Health.

"Conditions treated include COVID/URI symptoms, rashes, UTI, ear and eye complaints, musculoskeletal injuries and so much more. The program began with COVID-only evaluations in March 2020, and quickly expanded to providing a wider range of telehealth services under UCTH in July 2020."

Virtua Health kicked off the UCTH services specific to COVID-19 in early March 2020, and now it's an inherent part of the business, said Dr. Tarun Kapoor, the health system's chief digital transformation officer.

"Design-wise, the UCTH services were not set up as pages upon pages of questionnaires," he noted. "Adopting the 'Get human fast' concept, Virtua Health created virtual interactions with patients. What we soon discovered is that those first minutes resonated immensely with some of our target population."

Second, COVID Inpatient Remote Patient Monitoring, or IPRPM.

"Under the IPRPM program, adult inpatients with COVID can be discharged home to the inpatient COVID RPM program with a pulse oximeter device," Skrzynski explained. "Once home, they are supported by Virtua Health's nurses, who manage population healthcare outreach, as well as physician-led telehealth visits over the course of two weeks to help guide the patient on the road to wellness.

"At first, staff and clinicians inventively created a specialty kit comprising a Bluetooth-enabled tablet, blood pressure cuff, weight scale and pulse oximeter device to communicate virtually with these patients," she continued. "As the number of kits decreased, Virtua Health quickly discovered that the program was equally successful utilizing its video visit technology platform supported by a basic pulse oximeter only."

"This month, Virtua Health will launch its sixth telehealth program, Inpatient Warm Handoff to Outpatient Social Worker, a state-mandated, quality-based payer reimbursement program for behavioral health and pregnant patients discharged from the inpatient setting."

Dr. Angela Skrzynski, Virtua Health

This modified platform allowed staff to reserve kits for patients with conditions such as chronic obstructive pulmonary disease and chronic heart failure who needed access to blood pressure cuffs and weight scales.

Third, COVID Emergency Department Remote Patient Monitoring, or EDRPM.

"Under EDRPM, patients with COVID diagnoses who are deemed appropriate can be discharged from the emergency department and transitioned to the EDRPM program for COVID," Skrzynski said. "Patients are provided with a fingertip pulse oximeter device and one to three scheduled telehealth visits with a physician to ensure illness improvement."

Fourth, Care After COVID, or Long Haulers Program.

"Care After COVID is an integrated and comprehensive care program for patients experiencing increasing COVID symptoms over 30 days," Skrzynski explained. "Common symptoms include, but are not limited to, shortness of breath, fatigue, brain fog, palpitations, hair loss, muscular deconditioning and more.

"Patients complete questionnaires online and are seen for a lengthy initial evaluation via video consults," she continued. "Follow-up visits are scheduled as needed, and the patient is released from the program when improved."

Fifth, Cardiothoracic Pre-Operative Introduction.

"Through virtual consultations, patients meet with their surgeon as a 'meet and greet' for pre-surgical evaluation, care plan education and instruction covering the intra-hospital transfers prior to the surgery," Skrzynski explained.

"The Cardiothoracic Pre-Operative Introduction telehealth program's workflow involves a sequence of steps to complete the virtual consult," she continued. "In short, immediately following a cardiac catheterization that has abnormalities warranting cardiothoracic surgical evaluation, the patient is given an opportunity to speak with a cardiothoracic surgeon in real time via an audiovisual encounter."

Family members and other caretakers can also be added to the encounter, and this, in turn, allows real-time feedback from the operating surgeon to assist in the patient's medical decision-making regarding proceeding with surgery.

"To that effect, digital interaction with patients allows cardiothoracic surgeons who are stationed at other sites within the Virtua Health enterprise to communicate with patients on demand without transportation delays," she added.

And sixth, Inpatient Warm Handoff to Outpatient Social Worker.

"This month, Virtua Health will launch its sixth telehealth program, Inpatient Warm Handoff to Outpatient Social Worker, a state-mandated, quality-based payer reimbursement program for behavioral health and pregnant patients discharged from the inpatient setting," Skrzynski explained.

"Oftentimes, patients have a difficult time following up with outpatient social workers post-discharge if they leave the hospital without instruction on how to maintain contact," she continued. "By engaging with the patient in a warm handoff via a chatbot prior to discharge as part of the discharge process, the social worker is able to identify and address any barriers to follow-up.

As a result, staff anticipate realizing higher quality of care outcomes in these two patient populations.

RESULTS

Virtua Health has had positive Net Promoter Score results.

Three combined telehealth programs ─ the COVID Emergency Department Remote Patient Monitoring, COVID Inpatient Remote Patient Monitoring, and Care After COVID (Long Haulers Program) netted an NPS of approximately 75%.

In other words, this customer research metric captured 75% of Virtua Health patients' loyalty and satisfaction, rating the telehealth programs as likely to refer people.

"Waiting 10 years because we negotiated a decade-long contract does little to help solve the rapidly changing nature of healthcare. So internally, we're performing shorter iterations of technology assessments that enable us to foresee a road map ahead."

Danielle Wilson, Virtua Health

Virtua Health's digital health tools earned an NPS score of 80 in high patient satisfaction.

An internal survey of staff users and patients conducted in July 2021 found:

• 63% of Virtua Health's colleagues are aware that the Urgent Care Telehealth program exists.
• Most respondents feel that a reasonable wait time from login to connection with a clinician (aka live agent) is five to 10 minutes.
• Surveyed patients cite the web-based digital solutions easier to use and more accessible for engagement compared to apps with multiple, complex touchpoints.
• A 400% increase in patient usage of digital tools.

Then there is the throughput and impact on staff capacity and managing patients before and post implementation.

"Our clinical and administrative staff manages all patient communications," Skrzynski said. "Staff who use the chatbot can quickly redirect patients to the appropriate services within our larger healthcare community, resulting in more streamlined service offerings for both patients and staff.

"Additionally, the virtual care platform enables video consults and traditional telephone calls directly with the patient," she continued. "We best utilize chatbots by augmenting the technologies in use by our live agents. Whereas a traditional telephone call permits handling only one patient at a time, our platform empowers staff to toggle four or more patients simultaneously."

The Digital Transformation Office also impacted staff shortages. Virtua Health found that because the digital technology is intuitive, the training of staff and clinicians is seamless. Following a 20-minute training video, new employees are immediately ready to use the digital tools.

Outcomes for the telehealth programs also were positive.

First, Urgent Care Telehealth:

Of the patients seen in urgent care, about 15% make return visits. Volumes have increased steadily since the start of 2021, with an uptick after April 2021, the go-live month for the chatbot.

Virtua Health experienced a significant increase in patient volumes in the Urgent Care Telehealth program throughout 2021. For the month of December 2021, more than 1,200 patient encounters were documented.

Urgent care visits from non-COVID-19-related conditions continue to increase, as well. This surge is attributed to increased consumer awareness from informational campaigns, word of mouth and ease of use of the telehealth program.

Second, COVID Inpatient Remote Patient Monitoring:

Virtua Health reported a 32% relative reduction in hospital readmissions; 97% of patients felt more comfortable knowing a nurse was checking on them; and 92% would recommend to others.

Third, Emergency Department Remote Patient Monitoring (EDRPM):

In 2021, there were 1,100 patients enrolled in the EDRPM program. Of that number, patients experienced a 43% relative reduction in 14-day ED return visits.

COVID-19 patients diagnosed and stabilized in the ED went home with a pulse oximeter, a device that slips onto a person's fingertip to measure blood oxygen levels and monitors their clinical status at home through blood oxygen levels.

Fourth, Cardiothoracic Pre-Operative Introduction:

The cardio thoracic surgery virtual consultation services give Virtua Health the opportunity to reduce leakage by about 20 to 25 cases per quarter. Leakage and other financial analysis data drove the staff to create this program.

ADVICE FOR OTHERS

"Whenever we share outcomes with the organization, we do our absolute best to speak in numbers ─ and not in anecdotal evidence," Kapoor advised. "To quote professor Aswath Damodaram of New York University Stern School of Business, 'Without data, all we have is fairytales.'

"For example, if we're discussing change management, every one of our reports has a data point," he explained. "We also trend our data findings. That is a huge leveling up in prioritizing data analysis, thanks especially to Danielle and her team. For every digital project kickoff, the dashboard is up and running for us to observe and assess what's working and what's not."

It's easy for an organization to have a "set it and forget it" mentality, said Danielle Wilson, assistant vice president of digital transformation at Virtua Health.

"You implement a solution and it could be best-of-breed at the time," she said. "But, waiting 10 years because we negotiated a decade-long contract does little to help solve the rapidly changing nature of healthcare. So internally, we're performing shorter iterations of technology assessments that enable us to foresee a road map ahead."

Staff can gauge a better sense of timing about whether to engage "big box" vendors as opposed to working with a boutique vendor that can expand Virtua Health's digital ecosystem and drive a much better patient experience, she added.

"A four- to six-week project life cycle is how we think in terms of planning and scaling digital technologies to iterate upon our health system's virtual health environment," Kapoor advised. "For instance, what enhanced patient engagement innovations can we accomplish in six weeks? A digital health solution has to be safe. It has to be solid. And, it has to have quality, obviously.

"But the solution doesn't have to be perfect," he added. "Perfect doesn't get us anywhere fast. That type of atypical thinking is a shift in traditional organizational behavior common amongst traditional healthcare providers. When doctors like Angela and myself are involved, the ability to accelerate rapid virtual care adoption to create sustained change in quality care becomes the standard."

Many organizations strive to do things that get to 99%, Wilson stated.

"So many people have been ingrained with this 'MBA Six Sigma' mentality," she observed. "The reality is that for healthcare, the solution has to be good enough and it has to be safe and medically sound. But if you get 80% of automation, or 80% of patients taking on the self-service themselves, you're essentially allowing your workforce to take care of the complex patient or the information that is highly complicated to schedule or engage with the patient.

"We're automating that 80/20 rule by allowing for some pieces that don't fit the box, yet have the human-connection fit, while possibly requiring additional support," she concluded. "It's simply a different way of thinking about technology implementations."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.